Bisphosphonates have a reasonably safe renal profile in the treatment of osteoporosis, as long as they're used in the right patients, researchers found.

Action Points

Note that this review of published studies suggests that bisphosphonates carry relatively little risk to kidney function, despite the warning against their use in patients with eGFR less than 35 ml/min/1.73m2.

Be aware that the authors do not, however, recommend bisphosphonate use in patients with eGFR <35ml/min/1.73m2.

Bisphosphonates have a reasonably safe renal profile in the treatment of osteoporosis, as long as they're used in the right patients, researchers found.

In a review of the literature, clinical trials and post-marketing data for both oral and intravenous bisphosphonates showed no long-term effects on kidney function, Paul Miller, MD, of the University of Colorado Health Sciences, and colleagues reported online in the Journal of Bone and Mineral Research.

Bisphosphonates "have historically been associated with a low incidence of renal adverse events," Miller and colleagues wrote. "This review of clinical trial and post-marketing surveillance data has shown that, if used with care and in accordance with the prescribing information, these agents can be administered to patients with various degrees of renal impairment, with no long-term decline in renal function."

Similar incidences of renal adverse events, impairment, and function were reported for zoledronic acid and placebo groups over the duration of the trials, even in an older study population and in those who'd been taking the drug for up to 6 years, the researchers noted.

There were no data comparing the renal effects of IV ibandronate with IV zoledronic acid in a randomized population -- but there's no evidence of any differences in renal effects between these two bisphosphonates, they added.

"Clinical trial results have shown that even in elderly, frail, osteoporotic patients with renal impairment, intravenous bisphosphonate therapy administration in accordance with the prescribing information did not result in long-term renal function decline," they wrote.

They advised that clinicians follow guidelines for bisphosphonate therapy at all times, and given the prevalence of kidney impairment in patients with osteoporosis, "it is critical that clinicians know which patients are suitable for treatment with specific bisphosphonates."

For instance, physicians should check patients' creatinine clearance (CrCl) and estimated glomerular filtration rate (eGFR) before they start them on treatment. And in patients with marginal eGFR values, physicians should perform a "well-hydrated 24-hour CrCl for eGFR calculation before clinical management decisions are made with regard to bisphosphonate use."

Miller and colleagues concluded that their work shows the risk-benefit ratio for all bisphosphonates "is very favorable when they are used according to the label in the right patient populations for the right duration, and that IV bisphosphonates ... can even be used in the majority of patients, including those who are elderly, as long as their eGFR is >35 mL/min."

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